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. 2022 Feb 23;22(1):203.
doi: 10.1186/s12885-022-09299-5.

Breast cancer screening in sub-Saharan Africa: a systematic review and ethical appraisal

Yehoda M Martei  1   2 , Bege Dauda  3 , Verna Vanderpuye  4
Affiliations

Breast cancer screening in sub-Saharan Africa: a systematic review and ethical appraisal

Yehoda M Martei et al. BMC Cancer. .

Erratum in

Abstract

Background: The aim of this systematic review was to evaluate the evidence and clinical outcomes of screening interventions and implementation trials in sub-Saharan Africa (SSA) and also appraise some ethical issues related to screening in the region through quantitative and qualitative narrative synthesis of the literature.

Methods: We searched Pubmed, OvidMEDLINE, Embase, and Web of Science to identify studies published on breast cancer screening interventions and outcomes in SSA. Descriptive statistics were used to summarize the frequency and proportions of extracted variables, and narrative syntheses was used to evaluate the clinical outcomes of the different screening modalities. The mixed methods appraisal tool was used to assess the quality of studies included in the review.

Results: Fifteen studies were included, which consisted of 72,572 women in ten countries in SSA. 63% (8/15) of the included publications evaluated Clinical Breast Examination (CBE), 47% (7/15) evaluated mammography and 7% (1/15) evaluated ultrasound screening. The cancer detection rate was < 1/1000 to 3.3/1000 and 3.3/100 to 56/1000 for CBE and mammography screening respectively. There was a lot of heterogeneity in CBE methods, target age for screening and no clear documentation of screening interval. Cost-effective analyses showed that CBE screening linked to comprehensive cancer care is most cost effective. There was limited discussion of the ethics of screening, including the possible harms of screening in the absence of linkage to care. The gap between conducting good screening program and the appropriate follow-up with diagnosis and treatment remains one of the major challenges of screening in SSA.

Discussion: There is insufficient real-world data to support the systematic implementation of national breast cancer screening in SSA. Further research is needed to answer important questions about screening, and national and international partnerships are needed to ensure that appropriate diagnostic and treatment modalities are available to patients who screen positive.

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Conflict of interest statement

The authors have no financial and non-financial competing interests.

Bege Dauda, PhD, is a post-doctoral fellow in the Medical Ethics Division at the University of Pennsylvania in Philadelphia. His academic focus is on ethico-legal challenges and opportunities of benefit sharing in genomic research in Africa, focusing on the H3 Africa initiative. He also has an interest in the ethics of sample sharing and transfer as well as capacity building in research in Low- and Middle-Income Countries.

Verna Vanderpuye, MD, is a radiation and medical oncology physician with over 20 years of experience in treating cancer patients, training young physicians, nurses and other allied health workers and research into cancer in Africa. She has served on committees which influence care and research including the World Health Organization, American Society of Clinical Oncology, European Society of Clinical Oncology and the African Organization for Research and Treatment in Cancer. Dr. Vanderpuye works to improve delivery of academic content to African practitioners and researchers on the continent and is helping to move forward the agenda of implementation research.

Figures

Fig. 1
Fig. 1
Flow chart of the study selection process
Fig. 2
Fig. 2
Distribution of quality criterion met by quantitative studies
See this image and copyright information in PMC

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